Occult scaphoid fractures:: Comparison of multidetector CT and MR imaging -: Initial experience
Occult scaphoid fractures:: Comparison of multidetector CT and MR imaging -: Initial experience
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DOI：
10.1148/radiol.2401050412
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发表时间：
2006-07-01
期刊：
影响因子：
19.7
通讯作者：
Prokop, M
中科院分区：
文献类型：
--
作者：
Memarsadeghi, M;Breitenseher, MJ;Prokop, M
目的：比较多层螺旋CT(CT)和磁共振(MR)在临床疑似舟状骨骨折患者中的诊断效果，并以创伤后6周获得的X线片为参照标准。材料和方法：伦理委员会批准该研究，所有患者均给予书面知情同意。29例患者(男17例，女12例；年龄17~62岁，平均34岁+/-13岁)在伤后6天内进行了多层螺旋CT和MR成像。CT数据采用0.5 mm准直。为了进行图像回顾，在横断面、冠状面和矢状面上相对于手腕进行了0.7 mm厚的多平面重组。1.0-T磁共振检查包括冠状位和横位短反转时间反转恢复序列、冠状位和横位T1加权自旋回波序列和冠状容积再现T2加权梯度回波序列。两名放射科医生分析了CT和MR图像。采用二项式检验评价MRI和CT在发现舟状骨骨折和皮质受累方面的差异(P<；0.05)。结果：随访6周的X线片显示11例(38%)舟状骨骨折。8名患者有皮质骨折，而3名患者在舟状骨的小梁部分仅有带状透明。磁共振成像显示了所有11个骨折，但只有两个皮质骨折。多层螺旋CT显示了全部8处皮质骨折，但未能显示小梁骨折。MR或CT图像均未见假阳性骨折。MR与CT对腕舟骨骨折的检出差异无统计学意义(P=.25)，但对皮质受累有显著差异(P=.03)。结论：多层螺旋CT对隐匿性皮质舟骨骨折的显示具有较高的准确性，但对单纯小梁损伤的显示不如MR成像。磁共振成像在显示皮质受累方面不如多层螺旋CT。
Purpose: To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging in patients clinically suspected of having a scaphoid fracture and who had normal initial radiographs, with radiographs obtained 6 weeks after trauma as the reference standard.Materials and Methods: The ethics committee approved the study, and all patients gave written informed consent. Twenty-nine patients ( 17 male, 12 female; age range, 17 - 62 years; mean age, 34 years +/- 13) underwent multidetector CT and MR imaging within 6 days after trauma. CT data were obtained with 0.5-mm collimation. For image review, 0.7-mm-thick multiplanar reformations were performed in transverse, coronal, and sagittal planes relative to the wrist. The 1.0-T MR examination consisted of coronal and transverse short inversion time inversion-recovery, coronal and transverse T1-weighted spin-echo, and coronal volume-rendered T2-weighted gradient-echo sequences. Two radiologists analyzed the CT and MR images. A binomial test was used to evaluate the significance of the differences between MR imaging and CT in detection of scaphoid fractures and cortical involvement ( P < .05).Results: The 6-week follow-up radiographs depicted a scaphoid fracture in 11 (38%) patients. Eight patients had a cortical fracture, while three patients had only a bandlike lucency within the trabecular portion of the scaphoid. MR imaging depicted all 11 fractures but only two cortical fractures. Multidetector CT depicted all eight cortical fractures but failed to depict trabecular fractures. No false-positive fractures were seen on MR or CT images. Differences between MR imaging and CT were not significant for the detection of scaphoid fractures ( P = .25) but were significant for cortical involvement (P = .03).Conclusion: Multidetector CT is highly accurate in depicting occult cortical scaphoid factures but appears inferior to MR imaging in depicting solely trabecular injury. MR imaging is inferior to multidetector CT in depicting cortical involvement.